Purpose :
Investigate and report visual outcomes at 2 years in neovascular AMD patients with persistent active disease on OCT monitoring treated with ≥9 aflibercept injections up to week 56 from treatment initiation, followed by variable dosing frequency through week 104, from an ongoing multi-center audit.

Methods :
We conducted a retrospective study of visual acuity (VA) and treatment frequency data derived from anonymised EMR database compiled from the 17 UK National Health Service centers comprising the United Kingdom Aflibercept Users Group. Only patients receiving ≥ 9 aflibercept injections in the first 56 weeks were included. Mean VA was recorded at 4-weekly intervals from week 0 to week 104, and mean VA over time was stratified and analyzed by number of injections given in year 2.

Results :
Less than 5% of the total eyes were treated with more injections than the posology for Aflibercept at 56 weeks. 239 eyes of 231 patients met the criteria. Mean VA improvement from baseline to week 52 was +7.9±14.9(SD) ETDRS letters, from a baseline mean VA of 56.3±14.6(SD). Mean VA at week 104 was 62.3±17.2(SD) letters, representing a gain from baseline of 6 letters. The mean number of injections in year 2 was 6.7 (range 0-12), with 26.8% of eyes receiving 5 or fewer injections. At the year 2 visit, a VA gain from baseline of ≥15 letters was observed in 28.45% of all eyes, 3.35% lost ≥15 letters from baseline, and 44.35% of eyes achieved VA ≥70 letters. For eyes treated with 6 or more injections in year 2, 48% achieved VA ≥70 letters. There was a mean VA improvement from baseline to week 104 of 7.5 letters in eyes receiving 4-5 injections in the second year (N=48), compared with a mean VA letter gain of 5.7 and 5.4 letters in eyes receiving either ≥6 injections (N=172) or ≤3 injections (N=16), respectively.

Conclusions :
The recommended posology for aflibercept in newly diagnosed neovascular AMD in the UK is 3 consecutive monthly doses followed by bimonthly injections in the first year (average 7 injections). Less than 5% are being given ≥ 9. This group of patients tend to still require a high number of injections in the second year (mean 6.7) but do maintain VA improvements from baseline that ranged from +5.4 to +7.5 letters at week 104.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.